药师随访助力慢性心衰患者药物治疗管理

目的 建立慢性心衰患者药师门急诊随访管理体系，探讨药师指导患者规范化药物治疗的效果。方法 在首都医科大学附属北京世纪坛医院及内蒙古通辽市第二人民医院建立门急诊心衰患者药师随访体系，医师与药师共同制定慢性心衰患者个体化的药物治疗方案，分别评价肾素-血管紧张素-醛固酮系统（renin-angiotensin-aldosteronesystem，RAAS）抑制药及β受体阻滞药使用整体情况及用量达靶剂量的比率，治疗前后患者心功能及心脏结构变化情况、生化指标变化、安全性等。结果 随访患者RAAS抑制剂和β受体阻滞药用量达靶剂量的比率均为80.0%。规范化药物治疗后患者心功能较治疗前显著改善；初始左室舒张末期内径（left ventricular end diastolic diameter，LVEDD）增大的患者治疗后左室射血分数（left ventricular ejection fractions，LVEF）显著升高，LVEDD显著减小。药师随访干预后患者心率、血压、NT-proBNP、白蛋白、血钾水平指标较干预前显著改善。随访期间3例患者因恶性心衰死亡，其余患者无一过症状性低血压发生，耐受良好。结论 建立门急诊慢性心衰患者药师随访指导患者规范化药物治疗，大部分患者RAAS抑制药及β受体阻滞药等药物用量能达到指南推荐的靶剂量，并获得满意临床疗效及安全性。

Pharmacist Follow-up Aid in the Medication Therapy Management for Patients with Chronic Heart Failure

OBJECTIVE To establish the pharmacist's management system of chronic heart failure patient in outpatient and emergency room, and to explore the effect of pharmacist's instruction of standardized medication therapies for patients. METHODS To establish the pharmacist's management system of chronic heart failure patient in Beijing Shijitan Hospital Affiliated to Capital Medical University and Tongliao Second People's Hospital of Inner Mongolia. Physicians and pharmacists cooperated in making individualized medication treatment plans for patients with chronic heart failure, to evaluate the renin angiotensin aldosterone system(RAAS) inhibitors and β receptor blockers usage and ratio of treatment dose reached target dose, the changes of cardiac function and cardiac structure, biochemical indexes and drug safety before and after treatment. RESULTS The ratio of RAAS inhibitor treatment dose and the β receptor blockers treatment dose reached target dose in follow up patients were all 80.0%. After standardized drug treatment, the patients' cardiac function was significantly improved compared with before treatment, and the left ventricular ejection fractions(LVEF) of the patients with increased left ventricular end diastolic diameter(LVEDD) increased significantly and LVEDD decreased significantly. After the pharmacists' follow-up intervention, the parameter of heart rate, blood pressure, NT-proBNP, albumin and blood potassium were significantly improved compared with before intervention. During the follow-up period, 3 patients died of malignant heart failure; other patients had no symptomatic hypotension and were well tolerated. CONCLUSION With the establishment of the pharmacists' follow-up to instruct the standardized medication therapy of chronic heart failure patients in outpatient and emergency room, most patients' RAAS inhibitors and β receptor blockers and other medications' usage can reach the target dose recommended by the guidelines, and obtain satisfactory clinical efficacy and safety.